Traditional Private Practice may not Survive VT Reforms

by Vermonters for Health Care Freedom

GMC Board Member: Traditional Private Practice may not Survive VT Reforms

The decision of Fletcher Allen and Dartmouth Hitchcock to join forces and create an Accountable Care Organization (“OneCare Vermont”) for the whole state has antenna going up all over the place. ACO’s are basically Managed Care Organizations operated by providers. They are encouraged by both the Affordable Care Act and Vermont’s Act 48, because they facilitate the replacement of fee-for-service payment systems with global budgets, and global budgets are strongly preferred under Vermont’s single payer reforms.

Last week a Vermont physician in private practice who serves on the Green Mountain Care Board’s Technical Advisory Committee used an advisory committee meeting with the GMC Board to ask Board Member Dr. Alan Ramsay if the intention was to abolish fee-for-service private practice. Here is Dr. Ramsay’s response:

“In my world there are 3 types of practices: accountable care organizations, federally qualified health centers, and independent practices. Of the three, I fear most for independent practices. Their survival will depend on their willingness to collaborate with accountable systems.”

We should note that Dr. Ramsay was speaking for himself and not on behalf of the full board, but the implication is clear: traditional independent physician practices, which have been disappearing in recent years in response to government reimbursement formulas, may only survive if they accept the global payment reforms to be implemented through the ACO.

VHCF believes global budgets, like those used in Canada, will allow politicians to control spending by squeezing providers, who will then respond by limiting access through waiting list rationing.


Single Payer Advocates Blast Fletcher Allen/Dartmouth ACO Plan

What do the single payer folks think of the OneCare Vermont ACO? Dr. Peggy Anna Carey of Burlington penned a commentary for VTDigger and Physicians for a National Health Plan excoriating the move. Perhaps more telling was the affirming follow-up comment from Dr. Deb Richter, longtime VT single payer advocate and founder of VT for Single Payer and VT Health Care for All.

Here are some of the objections, in Dr. Carey’s own words:

“ACOs such as “OneCare” are a ruse for hospitals, insurers and providers to consolidate more of their clout to control their turf of profits. The Medicare Shared Saving Program that is encouraging the formation of these ACOs is based upon pilot studies that showed little savings and little improvement in care. . .

“In reality, OneCare Vermont ACO is a device for large medical organization like Fletcher Allen and Dartmouth in cahoots with for-profit insurance companies to maintain control of their vested interests.”

Newsletter notes that the single payer advocates have no problem expressing opposition to the consolidation of providers – and share VHCF’s concern for the impact on patient care – but in the same commentary express full faith in the monopolistic consolidation of the industry under the control of the government. Dr. Carey actually makes the statement that Green Mountain Care will “. . . eliminat[e] the morass of administrative waste created by the present health care situation that is virtually run by for-profit corporations.”

First of all, there are no for-profit hospitals operating in Vermont. Second, there are almost no for-profit insurers operating in Vermont. And third, is Dr. Carey aware of a single example in which the creation of a government monopoly to run anything resulted in the “elimination of administrative waste?”

The central concern of providers, policy advocates and government planners should be patient care. VHCF believes care is enhanced by respecting the need for doctors and patients to make critical care decisions without interference – by insurers or the government. Whether or not it benefits patients, OneCare Vermont is the logical provider response to Green Mountain Care, and the single payer advocates have no one but themselves to blame.

Dr. Carey’s VTDigger commentary is here:


Gubernatorial Candidates: Spreading Fear or Telling the Truth?

True North Reports published an article examining some of the claims being made by Governor Peter Shumlin and challenger Senator Randy Brock. To their credit, TNR pointed out that the governor continues to repeat the untrue claim that Vermont health care spending will double by 2020 if something radical is not done, i.e., single payer government control. The governor is fond of describing Brock’s call for a funding plan as ‘spreading fear,’ but how should one describe his own repeated exaggeration (by about 80%) of the expected spending increase?

The TNR story is here:


VHCF Commercial now on the Air

Last month VHCF posted a new commercial to our web site and announced that we would seek donations to run the ad on statewide television. Several thousand of you viewed the commercial on our site and through the VHCF Facebook page, and thanks to those who made donations the ad is now running on WCAX and WPTZ.

Vermont Today ran a story about the ad, available here:

The commercial can be seen right now at:

Donations remain critical to keep this and other messages before the public. Click here to DONATE:


Individualized Medicine – Our Last, Best Hope 

Dr. Richard N. Fogoros has published a book titled “Open Wide And Say Moo! – The Good Citizen’s Guide to Right Thoughts And Right Actions Under Obamacare.” Chapter 16 of the book is available online for free, and it speaks eloquently and expertly to the central concern VHCF raises about Green Mountain Care single payer government control which is at the heart of our new commercial message. The chapter is titled, “Individualized Medicine – Our Last, Best Hope,” and here are a few excerpts:

“Herd medicine – the top-down, centralized control of medical decisions as handed down by carefully selected panels of experts – is the hallmark of Progressive healthcare in general, and of Obamacare in particular. . .

“In this light, individualized medicine – using science and technology to tailor medical care to the best interest of the individual instead of the best interest of the herd – ought rightly to be seen as an existential threat to Progressive healthcare. Individualized medicine is the antithesis of herd medicine. If medical decisions are to be carefully tailored to the needs of each individual, centralizing the control of those decisions becomes impossible. Individual decision-making (and the individual autonomy that goes along with it) becomes necessarily predominant. It is hard to see how any truly Progressive healthcare system – and therefore, any truly Progressive system of government – can survive under a paradigm of individualized medicine. . . 

“It is therefore inevitable that Progressives will try to smother individualized medicine in its crib. They have made an excellent start at it, with a rigid government-controlled payment system that does not easily recognize new kinds of medical services, onerous regulatory policies that make it extraordinarily difficult to bring this type of product to market, and the enervated sclerosis of a medical profession struggling just to keep its head above water.” 

Chapter 16 of Open Wide And Say Moo! – The Good Citizen’s Guide to Right Thoughts And Right Actions Under Obamacare is available here:


Canadian Journalist Calls for end to Government Health Monopoly 

The Vancouver Sun contained a review of the new book about Canada’s troubled single payer government monopoly health care, titled Chronic Condition. The book is written by Jeffrey Simpson, the veteran Ottawa columnist for The Globe and Mail. The Sun writes:

“Simpson argues persuasively that the focus on protecting public access to health care by jealously guarding against private, for-profit providers limits is counter-productive. Almost a third of health care in Canada is already delivered privately and by insisting on maintaining a public-sector monopoly, we stifle innovation and ignore opportunities to get more and often better care for our limited resources.”

Vermont’s Green Mountain Care single payer government monopoly health care reform is designed after the Canadian system.

Read the full Vancouver Sun review here:


CALENDAR NOTES: The Green Mountain Care Board will undertake a discussion of benefits in the VT Health Benefits Exchange in their regular meeting on Thursday, October 4 between 1:00 and 5:00 pm.

The Department of Vermont Health Access (DVHA) is hosting a series of public forums this fall to educate Vermonters about the new Health Benefit Exchange, scheduled to launch in late 2013. On Wednesday, October 10, DVHA will present the information at the Bennington Free Library, 101 Silver St., between 6:00 pm and 8:30 pm.

Details and more information about upcoming events on health care reform can be found on the VHCF Calendar, available here: